Attorneys General Challenge Federal Rollback of Nursing Home Staffing Standards
– A coalition of 18 state attorneys general, led by California Attorney General Rob Bonta, has filed a comment letter challenging the federal government’s Interim Final Rule, which seeks to eliminate minimum staffing standards for long-term health care facilities. The coalition argues that overturning these standards, originally established through the Nursing Home Reform initiative, will negatively impact the quality of care and health outcomes for residents.
According to the comment letter, the Trump Administration is encouraging care homes to operate with minimal staffing levels, potentially depriving elders of necessary support. Attorney General Bonta stated, “Repealing existing standards is reckless and compromises public health, safety, and outcomes of residents in these care facilities, disproportionately affecting elders and minority communities. We urge the federal administration to prioritize the well-being of seniors over financial considerations.”
The Nursing Home Reform initiative, instituted by the Biden-Harris administration in May of 2024 at the suggestion of the Centers for Medicare & Medicaid Services, established minimum staffing standards for nursing hours per resident day. These standards included requirements for 24/7 on-site registered nurses and minimum staffing levels for certified nurse assistants. Studies associated with the reform indicate improvements in the quality of care, increased attentiveness, mitigation of negative outcomes, and potential savings of up to $465 million dollars in Medicare costs through reduced medical emergencies and hospitalizations.
The multistate coalition’s comment letter asserts several key points:
- Data demonstrates a correlation between increased nursing staff levels, including mandatory on-site registered nurses, and positive health outcomes for residents.
- Eliminating federal regulations widens the gap in quality of care between states, as some states, like California, New York, and Massachusetts, already have established staffing requirements.
- The Interim Final Rule requires the adoption of replacement staffing standards to prevent long-term care facilities from reducing costs at the expense of patient well-being.
- Federal regulations should not supersede existing or future state standards that provide higher levels of protection for residents.
Joining Attorney General Bonta in filing the comment letter were the attorneys general of Arizona, Colorado, Delaware, Illinois, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Rhode Island, Vermont, and Washington.
The Division of Medi-Cal Fraud and Elder Abuse, involved in this effort, receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $77,652,892 for Federal Fiscal Year 2026 (October 1, 2025 – September 30, 2026). The remaining 25 percent, totaling $25,884,297 for FFY 2026, is funded by the California Attorney General’s Office.
This action comes as states continue to grapple with the legacy of federal rollbacks under the Trump Administration, even as they pursue their own initiatives to address climate change and, now, healthcare standards. The coalition’s challenge highlights a continuing tension between federal and state authority in areas of public welfare.
